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Published: Sunday, April 21, 2013, 12:01 a.m.

Seniors' care dilemma

Many have no family to rely on for help as health declines

  • Dot, who lives alone in Richardson, Texas, has enlisted the help of a geriatric-care manager to help her maintain her affairs.

    Louis DeLuca/Dallas Morning News

    Dot, who lives alone in Richardson, Texas, has enlisted the help of a geriatric-care manager to help her maintain her affairs.

At 81, Dot lives in an independent living facility in Richardson, Texas. She's single with no children and her closest relative is a cousin in Oklahoma City.
But thanks to a strong support system, she won't be alone as she ages and her health inevitably declines.
Being alone "doesn't scare me because I know that I have friends," Dot said.
Billie, 80, isn't as fortunate. Her husband is deceased, leaving her to live by herself in her DeSoto, Texas, home for the first time in her life.
Billie said her grown daughter has made it clear that she will not be her mother's caregiver in her old age.
"She thought that was too much responsibility for her," Billie said. "It's just devastating."
Dot and Billie, whose last names are being withheld for their protection, illustrate the opposite ends of a quandary facing many seniors: Who will take care of us in our frail, declining years?
Most of us hope that our family will step up and help out. But for an increasing number of seniors, that option isn't there. Whether they're estranged from family or have never married or had children, more and more people will find themselves alone as they age and their health declines.
"Those of us who practice elder law are no doubt seeing the fallout of this reality," said Brian Fant, a Dallas attorney. "That is, more and more isolated or alienated senior adults who either have no one, or (have) no one who can or will care for them."
Just who is going to care for single baby boomers as they face the inevitable ailments of old age isn't at all clear, said Susan L. Brown, co-director of the National Center for Family & Marriage Research at Bowling Green State University.
"Spouses, usually the first line of defense, will not be there," she said. "Some solo boomers may be able to turn to adult children or others in their extended families. But many will have to find sources of support and care in institutions or from their communities."
Experts say it's critical that the elderly find someone they can trust to take on financial and medical powers of attorney so someone will be able to make decisions about their financial affairs and medical care if they become incapacitated.
The goal is to avoid guardianship, which is expensive and strips a person of the right to make decisions about personal health and finances.
"You try to avoid that if you can," said John McNair, elder-law attorney at Barnett McNair Hall LLP in Dallas. "With powers of attorney, revocable living trusts, medical powers of attorney, HIPAA authorizations, you can usually avoid that."
Fant said he recently handled a guardianship case involving a man in his late 70s who went through "an ugly divorce" from his wife about 20 years ago. The man, who was living alone, had suffered significant brain damage in a fall.
"He had two adult children still living in the Dallas area, but had not seen or spoken to them in all that time. He was not married and had no one else. Because of the deep hurt associated with the divorce, when the time came that he needed his children's help, they refused," Fant said.
"This is only one of many similar stories, where either there is no one to help, or there is no one willing or able to help," he said. "For the individual who has no one, or who has no family willing to help because of fractured relationships, the anxiety and fear of the future is magnified."
Statistics suggest such a future awaits more seniors.
"There will be increasing numbers of older adults who do not have children," said Lynn Feinberg, an expert in caregiving at AARP. "About 20 percent of women are childless today, compared to 10 percent in the 1970s. This trend is going to continue."
She ticked off more predictive statistics:
The proportion of the frail older population -- people age 85 and older -- without any surviving children will increase from about 16 percent in 2000 to about 21 percent in 2040.
"That's significant," Feinberg said.
Divorce rates among baby boomers are surging. "Divorce rates among the population 50 and over have doubled between 1990 and 2010, which is startling," she said.
In an article she wrote for Scholars Strategy Network, Brown said "divorce in early or middle stages of adulthood has enduring consequences, especially for men.
"Divorced fathers are less likely than married fathers to receive care from their adult children. For mothers, marital status is immaterial, because adult children are equally willing to care for their married and divorced mothers."
Experts say a senior's support system can consist of people other than blood relatives.
"If you have a community, if you're connected to a church, it's going to be more likely that you'll get the help that you need," said Shelley Hamilton, who oversees Resource Center Dallas' newly expanded program for lesbian, gay, bisexual and transgender seniors.
Formerly pastor of congregational care at Dallas' Cathedral of Hope, Hamilton speaks from personal experience.
Hamilton is single and gives her age as "over 60." She has a brother and sister in Louisiana and a sister in California. Her sisters are in poor health, and while her brother is healthy, she doesn't want to put the responsibility of being her caregiver on him.
"We have a good relationship, and if I didn't have any other option, yes, he would be there for me," Hamilton said. "But it would be very difficult, especially since he took care of both of our parents and his wife's parents up until the time they died.
"He's been a primary caregiver and I would love to be able to spare him that."
Hamilton is confident that her circle of support in Dallas will come through for her.
"I think that I have a strong enough community here in Dallas to where my basic needs would be met," she said.
Part of a senior's support system can be doctors and other professionals, said Lue Taff, geriatric-care manager in the ElderCare Partners program at the Senior Source in Dallas.
Health care professionals can detect cognitive decline, which can affect the way seniors manage their money.
"There are so many people trying to make it on their own, and that makes them vulnerable to exploitation," Taff said.
That's why telephone scams are so successful with seniors, she said. The scammers exploit seniors' loneliness.
Taff has been a godsend to Dot. As her geriatric-care manager, Taff helps Dot with doctor appointments and keeping track of her medical history, managing daily challenges of living with hearing and vision deficits, getting devices to help make life easier, finding other resources, and planning for future needs.
One of the first tasks Taff and Dot took on was to put together a medical information kit "so that in the event I should be hospitalized, that all the information would be there," Dot said.
"I know that I've got the financial resources there, but I want to be able to manage those resources," she said. "A person never knows what's going to happen."
Dot no longer drives because of macular degeneration, and she just got hearing aids. Other than that, she's in good health.
"I'm going to be working with Lue, so she will be able to observe how I'm doing," she said. "The thing that I was most concerned about short-term was someone to help me with my financial record keeping, as my vision declined."
Like Hamilton, Dot has a supportive community around her.
She's active in the Dallas Downtown Republican Women's Club and belongs to a Sunday school class.
"I may get 20 emails or more in a day," she said. "I'm constantly in touch with people."
Billie and her husband had planned for independence in their old age.
"We had planned our lives on not being a responsibility to anybody," she said. "We didn't take vacations for several years because we had to keep upping our retirement plan because you just don't know."
Then her husband died in 2010, and her own medical problems began to mount.
Like Dot, Billie has macular degeneration. In addition, she has a brain aneurysm and has had a stroke.
Billie said her doctors give her two more years to live because of the aneurysm. For now, she plans on remaining in her DeSoto home -- alone.
Living with her daughter in central Texas is not really an option. "She had already said, sitting right here in our den, that she didn't plan to have funerals for either one of us," Billie said. "She did not know what we were going to do."
There is one condition under which she could stay with her daughter: "I could stay with her right now, but everything I've got would have to be signed over to her. She's made that very clear."
The daughter's reaction is not uncommon, said Suzanne Cobb, director of the Guardianship and Money Management Program at the Senior Source.
"Sometimes the situation is just more than they can handle," she said. "You see it frequently. A lot of times the person themself has alienated the family for whatever reason."
Whether or not they have family, seniors at some point must decide where they will live if they can no longer care for themselves, experts said.
Hopefully, it will be a place where they will have others around them.
"Social isolation is a killer," Cobb said. "Social isolation can speed up dementia, and you can die of a broken heart. We all need social interaction."
What you can do
Look for someone you can trust who is willing to be given your financial and medical powers of attorney. Make sure the person you select understands clearly what will be required of them if they assume those roles.
Be active in your community and church. The friends and connections you make there might serve you well in your time of need.
Look to health care professionals, such as your doctor, to spot signs of cognitive and physical decline that might endanger your ability to care for yourself.
Seek community organizations that specialize in serving seniors.
Story tags » Economy, Business & Finance

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